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BCOM2014-1016Bin # 441City Permit # �►v��,p - Project Address: of La Qulnta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta,CA 92253 -'(760) 777-7012 Building Permit_ Application and Tracking Sheet C1v Owner's Name: A. P. Number.5 (J- � ho'CA — S Address:.Cll Legal Description: 3'O U k6 IU 2 � VJS City, ST, Zip: N456" Clf i a Contractor: Telephone: �<�''�'�'«>?�'`• .h-::.,<,:;; Address: Project Description: City, ST, Zip:AF�n iJ5 Telephone: State Lie. # : City Lie. #: _ Arch., Engr., Designer:�kt^ SOb 9G O�t Address:2p�l 2W NJO kU— City, ST, ZipcNup t F` � Tele hone: V • S State Lie. #: 64,k b(o t) O ecu aneY •Constructi n TYPe: Project type (circle one): New Add nAlt . Repair Demo Name of Contact Person: ��� Sq. FL:'v # Stories: 41 Units: Telephone # of Contact Person: D �-{�7 Estimated Value of Project: # Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACKING PERMIT FEES. Plan SetsPIan Check submitted 9 8 Item Amount Structural Calcs. Reviewed, ready f corrections Plan Check Deposit Truss Cala. Called Contact Person q f Plan Check Balance • Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan Zed Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '`d Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees , P.O. BOX 1504 LA QUINTA; CALIFORNIA 92247-15'04 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICo (7 60) 777-7012 LA QUINTA, CALIFORNIA 92253 - FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures, & Forms for Owner -Builders. Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing' yourself as - the builder of the property improvements specified at !vQ 7u 97 �f1L�.1 We aow re providing you with an Owner -Builder Acknledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF. INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. L' I understand a frequent practice -of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own, labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries -sustained by an unlicensed person and his or her employees while working on my property, My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Ksnction I understand building permits are not required..to be signed by property owners unless they are responsible for the and are not hiring a licensed Contractor to assurne this responsibility. t63. I understand as an "Owner -:Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a Iicensed.Contractor and having the permit filed in his or her name instead of my own. AI understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on M -1 and contracts. 5. Lunderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500),' including labor and materials, I may be considered an "employer" \under state and federal law. -S6. I understand if I amconsidered an "employer" under state and federal.law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial ,ri(sskk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder. who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. f '" -k-8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. K_>9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. vs -10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. P12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I ave provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result'of a complaint. Your only remedy against unlicensed Contractors -may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification: acceptable•to the agency is required to be presented when the permit is issued to verify the property owner's signature. , Signature of property owners Date: l Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Proper Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. r f Scope of Construction Project (or Description of Work): a' L'l ty /I/_d ` 4- e-� 1 � C p 0) (/W C, Proiect Location or Address- q " y 7,7 F-1 kIN r<: c:, Irz. J A - Name of Authorized Agent: kc. 0 t-1 � U � 1 V 4 k-) Tel No ;, 6y -(o Address y - Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is requir d t be pr ted whe the permit is issued to verify the p oper owner's signature. 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